Use of Biochemical Markers of Infarction for Diagnosing Perioperative Myocardial Infarction and Early Graft Occlusion After Coronary Artery Bypass Surgery

Early graft failure after coronary artery bypass grafting: diagnosis and treatment

“…The diagnostic performance of these markers in the nonsurgical setting is very well described in numerous studies [14]. Holmvang et al [12] reported their study in 103 patients with a conclusion that serial postoperative biochemical data, preferably CK-MB mass and troponin T can identify a subgroup of patients with a high rate (20 to 27%) of early graft occlusion. However, diagnosis of peroperative myocardial infarction is associated with several problems.…”

“…The most common graft-related reasons for peroperative myocardial infarction are graft occlusion due to acute graft thrombosis, kinking or overstretching of the graft, subtotal anastomotic stenosis, injury of the graft during harvesting and graft spasm [4,11]. Non-graft-related peroperative myocardial infarction might be induced by different mechanisms during surgery, including inadequate cardioplegic perfusion and myocardial protection, incomplete revascularization, and distal coronary microembolization due to surgical manipulation [6,12]. These graft-related or non-graft-related etiologies induce myocardial hypo or malperfusion with regional myocardial dysfunction, leading to myocardial cell damage extending from the subendocardium to the subepicardium in a timedependent fashion which may all lead to myocardial necrosis with elevations of cardiac biomarkers and enzymes.…”

“…Myocardial infarction diagnosed by these two methods is associated with adverse outcome. Several studies have been reported the issue of diagnosing myocardial infarction by serial blood sampling for determination of CK-MB troponin I, and troponin T, and various cut-off limits have been suggested [9,10,12,13]. The diagnostic performance of these markers in the nonsurgical setting is very well described in numerous studies [14].…”

“…However, diagnosis of peroperative myocardial infarction is associated with several problems. Due to the surgical trauma and cardiopulmonary bypass, the usual non-invasive indicators of myocardial infarction such as pain, ECG changes, and elevated biochemical markers have less diagnostic value than in nonsurgical patients [11,12]. Transesophageal echocardiography will be able to identify an area with reduced contractility, but will be unable to provide the detailed information about the underlying cause.…”

Comparison of three strategies for myocardial protection during coronary artery bypass graft surgery based on markers of cardiac damage

“…40 ms in two consecutive leads on at least two post-CABG ECGs; (2) new R waves ! 40/50 ms in V 1 /V 2 on at least two post-CABG ECSs; (3) new, persistent, complete bundle-branch block compared to the pre-CABG ECG [13]. Enzyme criteria have been considered unreliable because of frequent unspecific elevation due to surgical tissue trauma, cardiopulmonary bypass, and transient ischemia during aortic cross-clamping [14].…”